202 Exam 3 Flashcards
(128 cards)
1
Q
Palpable sinuses
A
frontal and maxillary
ethmoid and sphenoid are too deep to palpate
2
Q
dry tongue can indicate
A
dehydration
3
Q
what are the three salivary glands and know location
A
parotid (largest)
submandibular
sublingual
4
Q
structures of the throat
A
oropharynx
tonsils
nasopharynx
5
Q
signs and symptoms of dehydration (assess oral cavity)
A
dry mucous
fissures in tongue
6
Q
aging adult oral cavity considerations
A
diminished small and taste
atrophic tissues
dental changes
mouth dryness
tooth loss
care of teeth/dentures
7
Q
normal nasal mucosa color
A
red smooth moist
8
Q
nasal mucosa: allergies
A
mucosa swollen
gray
9
Q
nasal mucosa: rhinitis
A
swollen, bright red, drainage
10
Q
assess for jaundice at the ___ for individuals with ____ pigmentation
A
buccal mucosa, dark
should be pink-brownish color
11
Q
No movement of the uvula
A
can show there is no gag reflex, don’t want to feed bc high risk for aspiration
12
Q
normal tonsils
A
oval shape, rough or granular appearance, visibility: 1+ (can visibly see tonsils) to 4+ (can’t see the uvula)
13
Q
infected tonsils
A
bright red and swollen
14
Q
perforated septum
A
A hole in the cartilaginous septum
Commonly caused by drug use (cocaine and methamphetamines), chronic infections, or trauma
15
Q
abnormalities of the lip: herpes simplex I
A
cold sore that evolve into pustules, which rupture, weep and crust
lasts about 4-10 days
contagious by direct contact
recurrent infections may be brought on by sunlights fever, colds, and allergies
16
Q
abnormalities of the buccal mucosa: leukoplakia
A
Lesions are precancerous and Chalky thick white raised patch with defined boarders
Lesion is firmly attached and does not scrape off
Lateral edges of tongue
Caused by chronic irritation of smoking and alcohol use
17
Q
abnormalities of the buccal mucosa: candidiasis
A
White cheesy curd like patches (thrush)
It does scrape off, leaving a raw, red surface that bleeds easily
Occurs after use of antibiotics and corticosteroids and in immunosuppressed people (HIV)
18
Q
abnormalities of the lip: carcinoma
A
An ulcer with rolled edges, indurated
Grows insidiously and may go unnoticed for months
lesions that is unhealed after 2 weeks should be referred
May have associated leukoplakia
19
Q
Abnormalities of the oropharynx: acute tonsillitis
A
Swollen tonsils with white or yellow exudate on tonsils
Accompanied by a severe sore throat, painful swallowing, and a fever over 101
20
Q
Abnormalities of the oropharynx: pharyngitis
A
Infection of the pharynx that causes Bright red swollen throat, white or yellow exudate on pharynx, swollen uvula
Accompanied by severe sore throat, painful swallowing, fever over 101
21
Q
what is an expected finding in darkly pigmented people
A
bluish lips
22
Q
Nonsynovial joints
A
United by fibrous tissue or cartilage and are immovable like the sutures in the skull or slightly moveable like the vertebrae
23
Q
muscles are ____% of body weight
A
40-50%
24
Q
Synovial joints
A
Freely moveable
Type of joint found where bones are separated from one another and enclosed in a joint cavity. Lined with synovial membrane that secretes synovial fluid (lubricant) which permits movement
Shoulder, hip, elbow, and knee
25
Skeletal muscles movements
flexion, extension
abduction and adduction
eversion and inversion
rotation
circumduction
elevation and depression
protraction and retraction
pronation and supination
26
temporomandibular joint
Depressed area anterior to the tragus
Permits jaw function for speaking and chewing
Allows three motions: hinge action to open and close the jaws, gliding action for protrusion and retraction, gliding for side to side movement of lower jaw
27
Osteoporosis
Decrease in skeletal bone mass leading to low bone mineral density (BMD) increases risk for fractures
more common in (white) women (after menopause)
28
Rheumatoid arthritis
Chronic inflammatory pain condition possibly started by an autoimmune response
Inflammation of synovial tissue, hyperplasia and swelling leads to fibrosis, cartilage and bone destruction
Joint involvement is symmetric and bilateral with heat, redness, swelling, and painful movement
29
Osteoarthritis (non-inflammatory)
Degenerative joint disease
Non inflammatory, localized, progressive disorder involving deterioration of articular cartilages
Asymmetric joint involvement commonly affects hands, knees, hips and lumbar and cervical segments of the spine
30
Uvula should rise with phonation
31
six cardinal gazes
parallel tracking in both eyes, muscle control
testing for nystagmus or misalignment in eyes
32
the aging adult eyes
Cataracts
Glaucoma
Dryness
Decrease in usual activities
Presbyopia
loss of central vision
33
presbyopia
decrease in power for eyes to accommodate (hyperopia or farsighted)
34
aging adult: loss of central vision
and risk factors
caused by macular degeneration- can cause blindness (peripheral vision is okay)
associated risk with HTN, diabetes, smoking, pesticides, family history, some medications
35
Osteoporosis
Decrease in skeletal bone mass leading to low bone mineral density
Increased risk for fractures
Occurs primarily in postmenopausal white women
36
Ankylosis
Stiffness or fixation of a joint
37
articular disease
ie. arthritis
inside the joint capsule
produces swelling and tenderness around the whole joint
decreases active and passive range of motion
38
crepitation
is an audible and palpable crunching or grating that accompanies movement
39
Phalen test
assess for carpal tunnel syndrome
ask person to hold both hands back to back while flexing the wrist at 90 degrees
after 60 secs if the test produces numbness and burning --> + for carpal tunnel
40
tests for carpal tunnel syndrome
phalen test and tinel sign
41
when swelling occurs in the knee, you need to distinguish whether it is caused by soft tissue swelling or increased fluid in the joint. comparison with the unaffected knee is important. which tests can you use to aid this assessment
Bulge sign and ballottement
42
McMurray test
test to check for meniscal tears
if you hear or feel a "click" = + for torn meniscus
43
lasegue test
confirms the presence of sciatica and a herniated nucleus pulposus
44
Ortolani maneuver
checks the hips for developmental dysplasia (DDH)
45
perform a _____ _____ to establish baseline and assess ADLs
functional assessment
46
Ankylosing Spondylitis
chronic inflamed vertebrae that is in extreme form leads to bony fusion of vertebral joints
affects the spine, pelvis, and thoracic cage (lower back stiffness)
47
most frequent type of joint dislocation
glenohumeral dislocation
48
three cranial nerves for extraocular movement: cranial nerve VI
The Abducens innervates the lateral rectus muscle (abducts the eye)
49
three cranial nerves for extraocular movement: cranial nerve IV
The Trochlear innervates the superior oblique (need it to “cross” your eyes)
50
three cranial nerves for extraocular movement: cranial nerve III
The Oculomotor innervates all the rest (most of the movement of our eyes)
51
Snellen eye chart tests
central visual acuity
higher the bottom number = the worst the vision (20/15 is better than 20/200)
52
age related macular degeneration
loss of central vision caused by yellow deposits (drusen) and neovascularity in the maculla
affects people over the age of 80 and women
fine tune vision is affected (peripheral vision is okay)
53
risk factors for macular degeneration
HTN, diabetes, smoking, pesticides, family history, some medications
54
preorbital edema
lids are swollen and puffy, accumulation of excess fluid
common in patients with CHF
55
anisocoria
unequal pupil size
affects 5% of the population
does not change to light stimuli
indicated CNS dysfunction (head injury, increased intracranial pressure) (medications such as narcotics and opioids)
56
eye accommodation test
assesses how pupils constrict to near objects
Looking at something far distance (pupils with relax and dilate) then put an object in front of them (pupils should constrict as they look at the close object) then bring closer (pupils converge)
CN 3 and 4
57
six cardinal gazes indicates muscle weakness during movement and will tell you which cranial nerve is affected
III III
\ /
VI --- eye --- III
/ \
III IV
58
pupillary light reflex direct and consensual
direct- look at one eye to see if it constricts with light
consensual- look at BOTH eyes to see if they constrict with light
59
normal pupil resting size
3, 4, or 5mm
60
red reflex
this reflex is the normal reflection from the scope light on the inner retina
cataracts will appear as opaque black
61
myopia
nearsighted
62
hyperopia
farsighted
63
open angle Glaucoma
most common type of glaucoma; virtually no symptoms are exhibited.
Vision loss begins with the peripheral vision, which often goes unnoticed because individuals learn to compensate intuitively by turning their heads.
64
Glaucoma vs cataracts
Glaucoma- condition where a buildup of pressure in the eye causes damage to the optic nerve which is the vital link of the eye to the brain which processes visual information
cataract- change in the lens of the eye; the result is cloudiness as light is prevented from entering the eye properly. (CLOUDY LENS)
65
Tympanic membrane (eardrum)
separates the external and middle ear, should be translucent, pearly-gray, and reflect light / vibrates from sound waves
66
Conductive hearing loss
CN VIII
dysfunction of external or middle ear (i.e. foreign bodies, perforated TM, otosclerosis)
67
Sensorineural (perceptive) hearing loss
CN VIII
pathology of Inner Ear, CN VIII, or Auditory areas of Cerebral Cortex (i.e. presbycusis, ototoxic drugs, brain injury)
68
presbycusis
Sensorineural hearing loss that affects the middle ear structures or causes damage to the nerve cells in the inner ear or CN VIII (gradual nerve degeneration)
affects men more than women (whites and Hispanics)
69
Otosclerosis
conductive hearing loss in young adults between 20 and 40
70
Labyrinth in the Inner Ear
constantly feeds imformation to your brain about your position in space
ie. vertigo
71
Vertigo
labyrinth becomes inflamed and feeds wrong information to the brain creating staggering gait and strong spinning/whirling sensation
sensation of spinning (subjective) or room is spinning (objective)
72
how to assess an infants ear vs adults ear
adults ear- pull pinna up and back
infants: pull pinna down
73
Tinnitus
ringing or buzzing in ear
74
swelling of mastoid process may indicate
ear infection
75
cone of light on TM
left ear: 7 o'clock
right ear: 5 o'clock
points towards nose
76
hearing acuity test
whisper test
tuning fork test: weber test and rinne test (more accurate in detecting conductive hearing loss)
77
Romberg test
assesses the ability of the vestibular apparatus in the inner ear to help maintain standing balance
also assesses intactness of cerebellum and proprioception
78
hypothalamus funciton
major respiratory center with basic vital functions: temperature, heart rate, blood pressure, appetite, sex drive
79
spinal cord mediates
reflexes
80
Pons and medulla
controls respiration
81
cranial nerve I
sensory
olfactory
smell
82
cranial nerve II
sensory
optic
sight
83
cranial nerve III
mixed
oculomotor
pupillary constriction, accommodation, and eyelid opening
84
cranial nerve IV
motor
trochlear
down and inward movement of eye
85
cranial nerve V
mixed
trigeminal
muscles of mastication (motor)
sensation of face, scalp, cornea
86
cranial nerve VI
motor
abducens
lateral movement of eye
87
cranial nerve VII
mixed
facial
facial muscles, close eye, speech, close mouth (motor)
taste on anterior 2/3 of tongue (sensory)
saliva and tear secretion (parasympathetic)
88
cranial nerve VIII
sensory
VESTIBULOCOCHLEAR
hearing and equilibrium
89
cranial nerve IX
mixed
glossopharyngeal
pharynx (phonation and swallowing) (motor)
taste on posterior 1/3 of tongue and gag reflex (sensory)
parotid gland and carotid reflex (parasympathetic)
90
cranial nerve X
mixed
vagus
pharynx and larynx (talking and swallowing) (motor)
general sensation from carotid body and carotid sinus (sensory)
carotid reflex (parasympathetic)
91
cranial nerve XI
motor
spinal accessory
movement of trapezius and sternomastoid muscles
92
cranial nerve XII
motor
Hypoglossal
movement of tongue
93
aphasia
loss of ability to understand or express speech
94
ataxia
difficulty with walking and balance, hand coordination
95
Decerebrate rigidity
upper extremities- stiffly extended, adducted; internal rotation, palms pronated
lower extremities- stiffly extended, plantar flexion, hyperextended back
indicates lesion in the brainstem at midbrain or upper pons
most ominous sign (poor prognosis - brain stem injury or damage)
96
Decorticate rigidity
upper extremities: flexion of arms, wrist, and fingers; adduction of arms
arms are tight against thorax
lower extremities: extension, internal rotation, plantar flexion
indicates hemispheric lesion of cerebral cortex (at or above the brainstem)
97
dysphasia
difficult speech
98
dysphagia
difficultly swallowing
risk for aspiration
99
cerebellum ataxia
staggering wide-based gait, difficulty with turns, uncoordinated movement (+ rombergs sign)
100
ataxia: parkinsons disease
motor system dysfunction
tremors/ rigidity/ cogwheel rigidity
facial expression: flat, staring, mask-like/expressionless
posture is stooped, elbows, knees, and hips are flexed. steps are short and shuffling
101
hemiplegia
one sided paralysis
102
tic
repetitive twitching (psychogenic or neurological)
103
tremor
involuntary contraction of opposing muscle groups
may occur at rest or with voluntary movement
104
important question to ask with head injury
did you loose consciousness and for how long?
105
phases of seizures
Preictal phase: Aura – subjective sensation that precedes a seizure: it can be auditory, visual, or motor
Ictal phase- time this, how long did it last and what occurred during (do not leave patient, call for help)
Postictal phase- get vitals and assess the patient
106
expressive (broca) aphasia
pt has difficultly expressing self. Understands us but Speak in broken speech
107
Receptive (Wernicke) aphasia
sounds like they know what they are taking about, word salad
108
global aphasia
expressive and receptive aphasia combined, most severe and most common
109
aging adult: neurological
Atrophy with steady loss of neuron structure in brain and spinal cord
Decreased or absent Achilles reflex, pupillary miosis, irregular pupil shape, and decreased pupillary reflexes
110
order of neurological exam
Mental Status
Cranial Nerves
Motor Nerves
Sensory
Reflexes
111
mental status assessment
ABCT
Appearance
Behavior
Cognition
Thought processes
112
how to test cranial nerve I
olfactory nerve
Test sense of smell in those who report loss of smell, with the person’s eye closed, occlude one nostril and present a familiar aromatic substance
113
how to test for cranial nerve II
optic nerve
Test visual acuity and visual fields by confrontation- snellen eye chart
114
how to test Cranial Nerves III, IV, and VI
oculomotor, trochlear, and abducens nerves
Check pupils for size, regularity, equality, direct and consensual light reaction, and accommodation
Assess extraocular movements by cardinal positions of gaze
115
testing muscle strength
Hand Grasp w/ push-pull
Plantar flexion & Dorsi-flexion w/ resistance
move correct limbs on command
116
testing cerebellar function
balance test: observe gait
Romberg test
rapid alternating movements (RAM): finger to finger test, finger to nose test, heel to shin test
117
grading reflexes
4+ very brisk
3+ brisker than average
2+ average / normal
1+ diminished
0 no response
118
positive babinski reflex
indicates a upper motor neuron lesion (stroke, brain injury, spinal cord injury)
119
Neurological recheck assessment
Level of Conscioiusness
Motor Function
Pupillary Response
Vital Signs
Glasgow Coma Scale
120
Glasgow coma scale
define the level of consciousness
A fully alert, normal person has a score of 15
A score of 7 or less reflects a coma
121
Stroke
Leading cause of long term disability
3rd leading cause of death
Most common symptoms
TIA (short lived) vs stroke (progressively get worse)
122
biceps reflex tests spinal nerves
C5 and C6
123
triceps reflex tests spinal nerves
C7 and C8
124
brachoradialis reflex tests spinal nerves
C5 and C6
125
quadriceps reflex tests spinal nerves
L2--L4
126
Achilles reflex tests spinal nerves
L5 - S2
127
cerebellum
motor coordination, equilibrium and balance
128
ototoxic drugs can cause
Sensorineural (perceptive) hearing loss (CN VIII)
